肌钙蛋白I对非ST段抬高急性冠状动脉综合征临床转归的预测价值  

Predictive value of positive troponin I in clinical prognosis of non-ST-segment elevation acute coronary syndrome

作　　者：姜立清[1] 赵明中[2] 胡大一[1] 

机构地区：[1]首都医科大学北京同仁医院心血管病诊疗中心,100730 [2]北京大学人民医院心血管病研究所

出　　处：《中华内科杂志》2005年第5期350-352,共3页Chinese Journal of Internal Medicine

基　　金：北京市科技基金资助项目(H010210330113)

摘　　要：目的　前瞻、多中心、随机对照研究肌钙蛋白(Tn)I阳性的非ST段抬高急性冠状动脉综合征病人(NSTEACS)发生心血管事件的危险程度,探讨TnI对其临床预后的预测价值。方法在10个医院入选起病后24h内就诊的NSTEACS患者,随机接受早期介入或保守治疗。随访30d和6个月,观察终点为心血管事件,包括心脏性死亡、非致命性心肌梗死、非致命性心力衰竭、因反复心绞痛发作住院。结果　6个月时,TnI阳性组患者因反复心绞痛住院及复合心血管事件明显增多,与TnI阴性组比较,差异有统计学意义(P<0 01)。早期介入干预可明显降低TnI阳性患者30d及6个月的复合心血管事件发生率(P值均<0 01)。结论　TnI阳性患者6个月心血管事件较TnI阴性者明显增加,TnI阳性是NSTEACS患者的预后预测因素。早期介入干预治疗能减少TnI阳性患者随访期内心血管事件的发生,不能使TnI阴性患者从中受益。Objective To investigate the predictive value of positive troponin I (Tn I) on early prognosis in patients with non-ST-segment elevation acute coronary syndrome (NSTE ACS), and to evaluate Tn I as a predictor of risk for the combined end points of cardiac events in NSTE ACS Methods 545 patients with non-ST-elevation acute coronary syndrome were double-blind randomly enrolled in two groups of study, receiving invasive or noninvasive treatment, respectively At admission, all patients′ baseline levels of Tn I and CK-MB were determined and related to outcome at 30 th day and 6 th month of follow-up Aspirin,β-blocker, ACEI and LWMH were given depending on patients′ clinical condition Results After a follow up of 6 months, hospitalization because of recurrent angina pectoris and combined end points of cardiac events in Tn I positive patients occurred much more as compared with that in the Tn I negative patients and the prognosis improved with early invasive interventional treatment strategy in the Tn I positive patients ( P <0 01) at 30 th day and 6 th month For Tn I negative patients, there was no difference between the two groups whether invasive or non-invasive therapy was given Conclusions There is high recurrence rate of angina pectoris and increased number of combined end points of cardiac events in positive Tn I patients during follow-up period Tn I served as an important risk factor in NSTE ACS patients and active early invasive intervention therapy should be the first choice for Tn I positive patients, but it makes no more benefits for Tn I negative patients.

关 键 词：肌钙蛋白Ⅰ 非ST段抬高 急性冠状动脉综合征 心血管疾病 

分 类 号：R541.4[医药卫生—心血管疾病]